Is digital technology a technical or adaptive problem in health?

Is digital technology a technical or adaptive problem in health?

Around three years ago I was invited to speak at a consultant psychiatrists committee meeting about social media and digital technology. I was mid way through my PhD and steeped in online ethnographic research about how people accessing mental health services and practitioners were making use of social networks. I had an inkling that I would have a mixed audience and I knew that not everyone would share my (then*) enthusiasm. As such I spent time preparing a range of compelling examples of digital technologies and social media practices, determined as I was to win over any detractors. I arrived a little early and so listened in to the tail end of an exasperated discussion about the various grinding limitations, obstacles and shortcomings of the in-house electronic patient record (EPR). If my audience’s primary experience of technology in health was such a bad one, then this did not bode well for my presentation – I quickly realised I was going to have to recalibrate. How could I be so naive as to think a conversation about the future potential of digital technologies would be welcomed, when the basics of reliable and effective electronic patient records seemed like a pipe dream? This experience came back to me whilst reading The Digital Doctor – Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age (Wachter, 2015) which is dominated by an expansive analysis of the shortcomings of contemporary electronic patient records. Wachter argues that EPRs have brought many a physician ‘to their knees’ with their clunky, confusing and complex systems (73). It is salutary to note that three years on...
Young people, social media and the ethics gap

Young people, social media and the ethics gap

“Adults ruined Facebook. Don’t do the same with Instagram. And don’t you DARE go anywhere near Snapchat!” This was the anguished cry of my teenager during a treasured moment of increasingly elusive mother/daughter conversation. Her plea reflects a wider shift in online teenager behaviour away from more public social networks towards more private ones such as Snapchat. As Facebook becomes more domesticated amongst adults, it appears that teenagers are heading to their own more private and separate spaces. The very idea that I might set up a Snapchat account was enough to fill my teenager with abject horror. So back to our conversation. I was secretly keen to check out ideas considered in Disconnected – Youth, New Media and the Ethics Gap (Carrie James, 2014) which I have just finished reading. The author considers how young people address ethical issues and moral dilemmas relating to privacy, property and participation online. Based on numerous interviews with young people aged 10 to 25 she found positive examples of highly ethical behaviour that evinced a ‘play nice’ mindset and which respected the privacy of others. However, she also found thoughtless, dismissive and occasionally callous behaviours towards others. Not surprisingly for young people who are still developing their sense of identity, attitudes were often highly individualistic and tended to focus predominantly on consequences of antisocial behaviour for the self rather than for others: Self-centred stances are not surprising given that egocentrism often characterises the adolescent and emerging adult phases of development. However, the dominance of egocentric thinking is problematic online, given the deeply social nature of the Internet and the qualities and opportunities...
“My profile works as a sort of filter” #TheProfileProject #7

“My profile works as a sort of filter” #TheProfileProject #7

@gopaldass AKA Abhay Adhikari tells the story behind his choice of Twitter profile pictures: “At the moment, my Twitter profile picture is of me cycling into the horizon, without a care in the world!  My account is a personal and professional space and my profile picture reflects this. It also serves as a personal reminder that I shouldn’t take myself too seriously and that I should take time to reflect on what others say. So much of social media is reactionary. “My picture changes quite often. Say, every couple of weeks. Every now and then I upload a profile picture that may indicate what I do for a living and where I live. For the most part, my profile picture is a reflection of how I am feeling and whether I want to actively connect with people at that point in time. By not giving it all away, I think my profile works as a sort of filter – engaging people who are curious, open minded and open to a chat. So far this approach as worked as I have met a lot of interesting people (in real life) via social media and this has allowed me to launch Digital Identity projects from Stockholm to Delhi!” You can find out more about #TheProfileProject here and connect on Twitter...
What does new power mean for the NHS?

What does new power mean for the NHS?

What do shifting societal trends towards a sharing economy mean for the NHS? Understanding New Power (Heimans & Timms, December 2014) sets out a framework to conceptualise shifts in power which are enabled by digital technologies in contemporary society: Old power works like a currency. It is held by few. Once gained, it is jealously guarded, and the powerful have a substantial store of it to spend. It is closed, inaccessible, and leader-driven. It downloads, and it captures. New power operates differently, like a current. It is made by many. It is open, participatory, and peer-driven. It uploads, and it distributes. Like water or electricity, it’s most forceful when it surges. The goal with new power is not to hoard it but to channel it.   The authors conceptualise a participation scale from consumption to co-owning, from old power models exemplified by Britannica to new power models such as Wikipedia. You can find out more about their framework in a fascinating Ted Talk given by Heiman here: Despite this being a contemporary framework, informed and enabled by digital technologies, it resonates with Shirley Arnstein’s Ladder of Participation which was published all the way back in 1969 and remains common currency in the field of NHS patient participation. Arnstein conceptualised an eight rung ladder of participation in decision making from manipulation and tokenism at the bottom to citizen control at the top. Heiman and Timm’s framework is like Arstein’s ladder, with the rocket fuel of technology as an enabler of new power possibilities for those of us who have access to the digital tools and literacy to take advantage of them.  ...
Dignity in a digital world

Dignity in a digital world

It’s easy to love or hate technology, to blame it for social ills or to imagine that it will fix what people cannot. But technology is made by people. In a society. And it has a tendency to mirror and magnify the issues that affect everyday life. The good, bad, and ugly. Danah Boyd Digital innovation is routinely heralded as the panacea for modern health and social care – creating more efficient and effective services, enabling patients to take more control of their health, and citizens to manage their transactions with government online. Personalised Health and Care 2020  (November 2015) sets out a framework for digital technologies with a bold ambition: One of the greatest opportunities of the 21st century is the potential to safely harness the power of the technology revolution, which has transformed our society, to meet the challenges of improving health and providing better, safer, sustainable care for all. To date the health and care system has only begun to exploit the potential of using data and technology at a national or local level. Our ambition is for a health and care system that enables people to make healthier choices, to be more resilient, to deal more effectively with illness and disability when it arises, and to have happier, longer lives in old age; a health and care system where technology can help tackle inequalities and improve access to services for the vulnerable. But in our rush to embrace digital technologies, are we paying proper attention to the implications for all of us as patients and citizens? What does digitally transformed health and care mean for...